J Trauma
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Multicenter Study Comparative Study
Variation in the management of pediatric splenic injuries in the United States.
This study examines the existence and sources of variation in the management of pediatric splenic injuries among hospitals in the United States and the factors associated with splenectomy. ⋯ Nationally, children cared for at freestanding pediatric hospitals have a significantly lower risk of splenectomy than children treated at either adult hospitals or pediatric hospitals within an adult hospital. This may have implications for education, trauma triage and the establishment of practice guidelines.
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Multicenter Study Comparative Study
The fastest route between two points is not always a straight line: An analysis of air and land transfer of nonpenetrating trauma patients.
The distance beyond which helicopter transport is faster than ground for interfacility transfer of trauma patients has not been established. Our objective was to determine whether such a threshold exists. ⋯ Several factors other than the distance to be traveled determine the time required for interfacility transfer of trauma patients. A fixed distance threshold beyond which helicopter transport should be used does not exist. The decision as to which mode of transport to use for emergent trauma patient transfers should be based upon multiple factors including the distance traveled and ambulance availability, and must be individualized for each site that transfers patients.
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Multicenter Study Comparative Study
The effect of a protocol of aggressive donor management: Implications for the national organ donor shortage.
The disparity between the number of people awaiting organ transplantation and the number of organs available has become a public health crisis. As many as 25% of potential donors are lost as a result of cardiovascular collapse (CVC) before organ harvest. A policy of aggressive donor management (ADM) may decrease the number of cadaveric donors lost as a result of CVC. ⋯ An aggressive donor management protocol decreases the number of donors lost as a result of cardiovascular collapse and increases the number of harvested organs per potential donor.
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Multicenter Study
Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury.
Prehospital management of traumatic brain injury (TBI) and trauma system development and organization are aspects of TBI care that have the potential to significantly impact patient outcome. This multi-center study was conducted to explore the effect of prehospital management decisions on early mortality after severe TBI. ⋯ The present study provides class II evidence that demonstrates a 50% increase in mortality associated with indirect transfer of TBI patients. Patients with severe TBI should be transported directly to a Level I or Level II trauma center with capabilities as delineated in the Guidelines for the Prehospital Management of Traumatic Brain Injury, even if this center may not be the closest hospital.
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Multicenter Study
Prevalence and prognosis of traumatic intraventricular hemorrhage in patients with blunt head trauma.
Most studies of traumatic intraventricular hemorrhage (tIVH) contain fewer than 25 subjects and are retrospective in design, providing minimal information about the entity and its clinical significance. ⋯ Traumatic IVH is rare and is associated with poor outcomes that seem to be the consequence of associated injuries. Isolated tIVH patients who are clinically well appear to have a functional outcome; we were unable to identify a case of isolated tIVH, combined with a normal neurologic examination, resulting in a poor or combined outcome.